Knee Arthritis

Arthritis is the loss cartilage in a joint. There are two kinds of cartilage in the knee joint. The first is the meniscus cartilage which is a soft, rubbery cartilage that sits between the bones. This is more commonly torn in people who are younger in athletic events or from squatting and twisting the knee. Older patients get another type of damage to the cartilage called arthritis.

Arthritis is really the wearing down or damage to the articular cartilage which is the cartilage at the end of the bone. When we examine the knee, the white shiny substance on the end of the bone is articular cartilage.

Arthritis is simply the damage or loss of that smooth cartilage. When it gets damaged the underlying bone can be exposed, which has a lot of nerve endings and can be very painful. Typical symptoms of arthritis are clicking, popping or swelling of the joint.


Understanding Arthritis Pain

When someone has arthritis it’s important to understand that the cartilage on the end of the bone actually doesn’t have any nerve endings. It’s the bone underneath it or the cells around the joint. So when someone has arthritis they’re getting swelling in the knee and the bone underneath the cartilage could be getting the pressure.

The pressure is what’s causing the arthritis pain. So if someone has mild arthritis they may have no pain at all. I’ve even had some patients that have significant arthritis in a joint and they’re not really having that much pain. I have some patients who have mild arthritis and have severe pain.

Part of it is how you’re dealing with the pain and part of it is how the nerves are exposed inside that joint.

Exercise and Physical Therapy for Knee Arthritis

It’s very important for everyone to work out but, depending on your condition, there are different work outs that you should do.

Someone who is going to physical therapy for arthritis has to avoid the specific activities that will aggravate your knee. Number one, the worst activity is squatting. That puts a lot of stress on the joint.

Number two, leg extensions. They have to avoid leg extensions, that’s where your knee is bent and you push it towards extension with resistance or weight. it’s very dangerous.

The best exercise to do for someone with knee arthritis is straight leg raising, which will strengthen your quadriceps. Hamstring Curls will strengthen your hamstrings. People who suffer from knee arthritis can even do bike and elliptical exercises as long as it doesn’t hurt too much. These can be extremely helpful to build up strength.

A simple exercise which a lot of people do is just walking. When you have arthritis in your knee walking really does make a leg stronger and gets rid a lot of the pain. Some people completely resolve knee arthritis doing good physical therapy. You should visit a physical therapist that is highly recommended by your doctor, not just someone you go to out of convenience because they are located near your home or where you work.

Strengthening the muscles that are around the knee joint help to stabilize the joint so it’s not moving abnormally and that helps get rid of the arthritis pain.

Arthroscopy Doesn’t Help Knee Arthritis

Something else which has been in the literature a lot recently is that arthroscopy doesn’t help with arthritis. Studies are showing that 50% of people do get better with arthroscopy for arthritis, that’s only for people who have mechanical symptoms.

I performed surgery on someone who had pretty significant arthritis in the knee but they had a big, loose piece of bone floating inside the joint.

Normally I don’t do arthritis surgery arthroscopically. But because this person had a loose piece floating around inside to joint, it was causing his knee to lock up, he couldn’t straighten it all the way and he was in a lot of pain.

The surgery was a simple arthroscopy which only took about 10 minutes to perform. I went in, cleaned the knee out and took out that loose piece of bone that was floating around. Now the patient is moving the knee with much less pain and he’s excited that he is able to do much more normal activities.

However, I didn’t fix his arthritis. I know that you think that arthroscopic surgery fixed arthritis. It does not but, it does take care of problems inside the knee such as a loose piece, which really helped this patient. a lot.

Who Gets Treated for Knee Arthritis

People with arthritis in their knees have a lot of pain typically going up and down stairs or with squatting. And it’s most common in patients who are older than 50 to 60 years old, but occasionally we do see it in patients who are younger.

Oftentimes with younger patients, the arthritis is due to a traumatic event such as a car accident or sometimes injuries playing football or even soccer if they really injured a joint. The knee is the most common joint that I see arthritis in is the knee.

It’s not uncommon for people to be told by their medical doctors or by their friends, “Oh you’re 65. You’re 70 years old. You must have arthritis.” It’s not necessarily true. So, before you start treating someone with arthritis, it’s important to get the right diagnosis and that’s why x-rays are extremely important.

Knee Arthritis Treatment

For knee arthritis treatment, a lot of times patients have swelling and just the fluid and swelling in a joint like the knee can cause pain. The first line of treatment when someone comes in to my office is to get an x-ray which is the best way to diagnose arthritis.

If we determine that the pain is arthritis and swelling, we can drain the knee. Taking the fluid out of the knee takes the pressure off the joint and makes it feel better.

Oftentimes I’ll put a cortisone injection into the joint which also helps keep the pain down for a longer amount of time and may even keep the fluid from coming back. There are other kinds of injections that we do for arthritis, mostly in the knees, are gel injections.

Gel Injections

When you have arthritis the levels of that lubricant, of the hyaluronic acid, is decreased. So what we do is inject this gel into the joint and it acts as a lubricant between the bone which helps 85% of our patients for an average of six months and sometimes they have lasted for up to two years.

Pain Medication

There are anti inflammatories including over the counter medicines such as Aleve or naproxen, ibuprofen, Motrin, which are somewhat effective. Tylenol is not very effective. But people can try that also. Usually by the time someone comes to see me, they’ve already tried some anti inflammatory. When the pain is really severe, rarely, but in case I will prescribe a stronger medicine, but that’s just short term.

Surgery as a Last Resort

When people have arthritis and they failed conservative treatment, and by that I mean physical therapy, exercises, injections, then it’s time to consider surgery.

But until someone gets really excellent physical therapy it’s not right to give the go ahead for surgery.

The main surgery for arthritis, if absolutely necessary, is joint replacement surgery which is extremely successful.  Knee joint replacement surgery is done by basically cutting off the arthritis and replacing it with either metal or plastic so that surfaces in your knee are not grinding against each other.

Don’t Delay Knee Arthritis Treatment

If you have something catching or rubbing inside the knee and you don’t deal with it, it can make things worse.

A patient with a loose piece of arthritis bone or cartilage floating inside the knee can cause more damage.

The worst thing is when patients start to lose motion in a joint is not getting that motion back. Physical therapy and anti-inflammatories can get that motion back, but if you don’t, you don’t want to live like that because you may never get it back including after having surgery.

So if someone starts to lose their motion and the pain is getting bad, you really got to see your orthopedic doctor, your orthopedic specialist as soon as possible. Don’t blow it off because otherwise you’re going to have severe loss of motion of that joint.

An injury may cause you to overcompensate and overuse another part of your body which can cause problems. You want to get the underlying issue solved before you do damage to something else as well.

Don’t just tough it out and deal with the pain. If you’re injured or the pain just started happening, you can give it a couple of days. But if it’s not getting better get it checked.

Contact Westchester Sport and Spine for a knee arthritis pain appointment.

Dr. Rick Weinstein, MD, MBA is an orthopedic surgeon specializing in sports medicine. He is the Director of Orthopedic Surgery at Westchester Sport and Spine and has subspecialty training in knee and shoulder surgery, including minimally invasive surgery and arthroscopy. Dr. Weinstein is a Board Examiner for the American Board of Orthopedic Surgeons, determining certification for other orthopedic surgeons.